Improved survival after obesity surgery in patients with previous myocardial infarction

Improved survival after obesity surgery in patients with previous myocardial infarction
Improved survival after obesity surgery in patients with previous myocardial infarction
October 26, 2020 – Researchers at Karolinska Institutet and Danderyd Hospital in Sweden have studied the risk of additional myocardial infarction and early death in severely obese patients undergoing metabolic surgery after a myocardial event. The registration study of 1,018 people shows a lower risk of additional myocardial infarction and improved survival that is not simply due to weight loss. The study is published in the journal Traffic.

According to the WHO and the measurement of the body mass index it created, there are currently two billion people who are overweight today, of which 650 million are classified as obese and whose body mass index (BMI) is over 30 kg / m2. Severe obesity (defined in this study as a BMI greater than 35 kg / m2) increases your risk of various health problems, including type 2 diabetes, high blood pressure, cardiovascular disease, and cancer.

People who lose weight can improve their health, and it has previously been shown that diabetes and hypertension move into a period of remission after metabolic surgery, during which symptoms disappear, at least temporarily.

SOReg and SWEDEHEART

In the current study, researchers from Karolinska Institutet, Örebro University, and Uppsala University looked at the risk of additional myocardial infarction and early death in people with severe obesity and previous infarction who had subsequently undergone metabolic surgery.

By cross-referencing the SOReg (Scandinavian Obesity Surgery Registry) and SWEDHEART (for people with myocardial infarction) quality registries between 1995 and 2018, researchers were able to identify severely obese individuals who had gastric bypass or gastric cuff treatment for their obesity after a myocardial infarction.

Gastric bypass separates a large part of the stomach and part of the small intestine. A stomach cuff is used to remove most of the stomach to leave a tubular structure that carries food into the intestines.

Lower risk of myocardial infarction

The group of 509 people who underwent surgery was compared to people of the same sex, age, and BMI who had had a myocardial infarction in the same year but had not undergone metabolic surgery.

“We found that people who had surgery for obesity had a much lower risk of having another myocardial infarction, dying, and developing heart failure,” said the study’s lead author, Erik Näslund, professor in the Department of Clinical Sciences of Danderyd Hospital. Karolinska Institutet and Consultant Surgeon at Danderyd Hospital. “These data suggest that severely obese people with myocardial infarction should be offered metabolic surgery for obesity as secondary prevention.”

Type 2 Diabetes Remission

According to the researchers, weight loss is unlikely to be the sole reason for the correlation observed in the study between metabolic operations and a lower risk of cardiopathic events such as stroke, myocardial infarction, or early death.

One theory suggests that metabolic surgery per se has positive effects on cardiometabolic risk factors, that is, on physiological conditions that increase the risk of cardiovascular diseases.

“Many of the patients who underwent metabolic surgery in this study had clinical remission from type 2 diabetes, high blood pressure, and dyslipidemia (high levels of fat in the blood). A previous study, Look AHEAD, showed that long, intense non-surgical interventions into lifestyle in patients with type 2 diabetes resulted in 6 percent weight loss but did not reduce the risk of myocardial infarction.

Further research through to practice is required

More research is needed before the study’s results can become part of clinical practice, in which severely obese people who have had a myocardial infarction are randomly assigned to either surgery or regular post-infarction care.

The study was carried out with the support of the Örebro Region and Stockholm Region.

Johan Ottosson is a member of the advisory boards of Johnson & Johnson and Vifor Pharma. Johnson & Johnson and Vifor Pharma did not know about the conception or implementation of the project and were not involved in it. There are no other declared conflicts of interest.

publication: “Association of Metabolic Surgery with Serious Adverse Cardiovascular Outcomes in Patients with Previous Myocardial Infarction and Severe Obesity: A Nationwide Cohort Study”. Erik Näslund, Erik Stenberg, Robin Hofmann, Johan Ottosson, Magnus Sundbom, Richard Marsk, Per Svensson, Karolina Szummer and Tomas Jernberg. traffic, online, October 26, 2020, doi: 10.1161 / CIRCULATIONAHA.120.048585.

For further information please contact:
Erik Näslund, Professor
Clinical Science Department, Danderyd Hospital, Karolinska Institutet
Phone: + 46 70 484 47 99
Mail: [email protected]

The Karolinska Institutet is one of the world’s leading medical universities. Our vision is to expand knowledge about life and strive for better health for all. Karolinska Institutet accounts for the largest share of all academic medical research carried out in Sweden and offers the broadest range of education in medicine and health sciences in the country. The Nobel Assembly at Karolinska Institutet selects the Nobel Prize winners in Physiology or Medicine.

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